title: Drug resistance in vectorborne parasites: multiple actors and scenarios for an evolutionary arms race.
abstract: Drug-resistant pathogens emerge faster than new drugs come out of drug discovery pipelines. Current and future drug options should therefore be better protected, requiring a clear understanding of the factors that contribute to the natural history of drug resistance. Although many of these factors are relatively well understood for most bacteria, this proves to be more complex for vectorborne parasites. In this review, we discuss considering three key models (Plasmodium, Leishmania and Schistosoma) how drug resistance can emerge, spread and persist. We demonstrate a multiplicity of scenarios, clearly resulting from the biological diversity of the different organisms, but also from the different modes of action of the drugs used, the specific within- and between-host ecology of the parasites, and environmental factors that may have direct or indirect effects. We conclude that integrated control of drug-resistant vectorborne parasites is not dependent upon chemotherapy only, but also requires a better insight into the ecology of these parasites and how their transmission can be impaired.
authors.affiliation: Unit of Molecular Parasitology, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Manu
authors.initials: M
authors.lastname: Vanaerschot
authors.forename: Silvie
authors.initials: S
authors.lastname: Huijben
authors.forename: Frederik
authors.initials: F
authors.lastname: Van den Broeck
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Dujardin
mesh_terms: D000818:Animals; D000977:Antiparasitic Agents / Q000494:pharmacology*; D005075:Biological Evolution; D004199:Disease Vectors; D004351:Drug Resistance / Q000502:physiology*; D006790:Host-Parasite Interactions; D006801:Humans; D010271:Parasites / Q000187:drug effects* / Q000235:genetics
chemical_list: D000977:Antiparasitic Agents
keywords: Leishmania; Plasmodium; Schistosoma; fitness cost; vectorborne diseases; virulence